Association between housing status and mental health and substance use severity among individuals with opioid use disorder and co-occurring depression and/or PTSD.

BACKGROUND

Opioid use disorder, mental health conditions, and housing instability are frequently intertwined and have a profound impact on health outcomes. While past research has focused on the opioid use and mental health of people experiencing homelessness, less is known about those experiencing housing instability. We examined the cross-sectional associations between housing status (currently unhoused, unstably housed, and stably housed) and mental health and substance use severity among primary care patients with co-occurring disorders.

METHODS

Data are from a randomized controlled trial, Collaboration Leading to Addiction Treatment and Recovery from other Stresses, which tests the Collaborative Care Model for primary care patients with opioid use disorder and co-occurring depression and/or post-traumatic stress disorder (PTSD). We defined being unhoused as not living in stable housing in the past 3 months and being unstably housed as living in stable housing but being worried or concerned about loss of housing in the next 3 months. We assessed differences in baseline characteristics across the housing groups using ANOVA for continuous variables and chi-squared tests for categorical and binary measures. Adjusted linear regression models were used to assess associations between housing status and mental health and substance use symptom severity scores.

RESULTS

Among the 797 patients randomized, 13% of the sample was currently unhoused, 24% was unstably housed, and 63% was stably housed. Individuals who were unhoused were on average younger, received less education, never married, and had not used prescribed medications for opioid use disorder (MOUD) in the past 30 days. The adjusted regression results showed that both being unhoused and being unstably housed were significantly associated with higher PTSD symptom severity, depression symptom severity, opioid use severity, and opioid overdose risk behaviors compared to being stably housed.

CONCLUSION

Primary care patients with co-occurring disorders who were either unhoused or unstably housed have worse mental health and substance use symptom severity when compared with stably housed individuals. This suggests primary care providers should screen patients with co-occurring disorders not only for being unhoused but also for unstable housing. Addressing housing instability in primary care settings could lead to improved health outcomes and reduced healthcare costs.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04559893, registered on January 8, 2021.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12875-025-02947-2.